双侧内囊前肢毁损术治疗难治性强迫症疗效及随访研究

Efficacy and 2-year′s follow-up study on bilateral anterior internal capsulotomy for patients with treat-resistant obsessive-compulsive disorder

目的 对难治性强迫症进行双侧内囊前肢毁损术治疗 ,评定手术疗效并进行 2年随访 ,以进一步探索脑外科手术对难治性强迫症的疗效 ,并探讨手术治疗的良好适应症。方法 对 2 8例难治性强迫症患者进行双侧内囊前肢毁损术治疗 ,并分别在手术前、手术后二周、手术后三月、手术后六月、手术后一年、手术后二年进行Y BOCS、HAMA、HAMD量表评定及术后疗效评定。结果 (1)强迫症患者手术后各期Y BOCS评分、HAMA评分与手术前比较均下降 ,有极显著差异 (P <0 .0 0 1) ;(2 )手术后各期Y BOCS的强迫思维评分均有明显下降 (P <0 .0 0 1) ,强迫行为在手术后 1年和 2年 ,与手术前比较无明显改变 (P >0 .0 5 ) ;(3)手术后 2年的总有效率为 5 3.5 % ,明显低于手术后 3月的总有效率 (P <0 .0 1)。结论 采用双侧内囊毁损术有相当的治疗效果 ,对于难治性强迫症患者可作为一种补充治疗手段 ;手术治疗对强迫行为的长期疗效较差 ,以严重的强迫思维为主的难治性强迫症患者为手术更好的适应症。

Objective: To evaluate the effect of operations on the treatment of treat-resistant obsessive-complusive disorder (TRO) with capsulotomy and follow them up for two years to further explore the effect of cerebral operations on the treatment of TRO and the proper indications. Methods: 28 TRO patients were treated with capsulotomy. Y-BOCS, HAMA and HAMD were used before, 2 weeks after, 3 months after, 6 months after, one year′s after and two years′ after the operation respectively. Results: The total scores of Y-BOCS and HAMA in all phases after capsulotomy were significantly lower than those before operation (P<0.001); the obsessive agent-scores in all phases after surgery were significantly lower than those before operation (P<0.001), while there was no significantly difference in the compulsive agent-scores between pre-surgery and one-year and two-year′ post- surgery (P>0.05); the total efficiency of two-year′s post-surgery was 53.5%, which was significantly lower than that of three-month′s post-surgery (P<0.01). Conclusion: The treatment of the TRO with capsulotomy is obviously effective, which may be considered as a compensatory way of treating TRO; the long-term efficacy in compulsive symptoms is not better than that in obsessive symptoms, so TRO with severe obsessive symptoms is the better indication of capsulotomy.